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Published on: December 11, 2017
Prognosis and outcome determinants after heart failure diagnosis in patients who underwent aortic valvular
Silvana Kontogeorgos1, Erik Thunström1, Aldina Pivodic2,3
1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Patients with heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS) have similar mortality risks and predictors compared to the general HF population. Prognosis is consistent regardless of left ventricular ejection fraction (LVEF).
Area of Science:
- Cardiology
- Heart Failure Research
- Aortic Valve Disease
Background:
- Heart failure (HF) is a significant clinical challenge, particularly in patients with a history of aortic stenosis (AS).
- Aortic valvular intervention (AVI) is a common treatment for AS, but its impact on subsequent HF development and prognosis requires further investigation.
- Understanding the specific characteristics and outcomes of HF post-AVI is crucial for optimizing patient management.
Purpose of the Study:
- To investigate the clinical phenotype, prognosis, and predictive factors for all-cause and cardiovascular (CV) mortality in patients experiencing incident HF after AVI for AS.
- To compare the outcomes of HF patients with preserved ejection fraction (AS-HFpEF) versus reduced ejection fraction (AS-HFrEF) post-AVI.
- To compare the prognosis of HF patients post-AVI with a matched general HF population without AS.
Main Methods:
- A retrospective observational study using data from the Swedish Heart Failure Registry (SwedeHF) from 2003-2016.
- Inclusion of patients diagnosed with AS and who underwent AVI prior to HF diagnosis.
- Subgroup analysis based on left ventricular ejection fraction (LVEF ≥ 50% for AS-HFpEF, <50% for AS-HFrEF) and matched controls with HF but without AS.
Main Results:
- The study included patients with incident HF post-AVI for AS, comparing them to matched HF controls without AS.
- Crude all-cause mortality was 49.0% and CV mortality was 27.9% in the AS-HF group, compared to 44.7% and 26.6% in controls, respectively.
- Adjusted analysis revealed similar risks for all-cause and CV mortality between AS-HF patients and controls, irrespective of LVEF. Predictors of mortality were also similar, with diabetes being a significant predictor only in the AS-HFrEF subgroup.
Conclusions:
- Patients with incident HF following AVI for AS exhibit similar all-cause and CV mortality rates and prognosis compared to the general HF population.
- The predictors of mortality in HF patients post-AVI are largely consistent across different LVEF categories.
- These findings suggest that HF management strategies for patients post-AVI should align with those for the broader HF population.
Aims:
To study clinical phenotype, prognosis for all-cause and cardiovascular (CV) mortality and predictive factors in patients with incident heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS).
Methods And Results:
In this retrospective, observational study we included patients from the Swedish Heart Failure Registry (SwedeHF) recorded 2003-2016, with AS diagnosis and AVI before HF diagnosis. The AS diagnosis was established according to International Classification of Diseases 10th revision (ICD-10) codes, thus without information concerning clinical or echocardiographical data on the aortic valve disease. The patients were divided into two subgroups: left ventricular ejection fraction (LVEF) ≥ 50% (AS-HFpEF) and <50% (AS-HFrEF). We individually matched three controls with HF from the SwedeHF without AS (control group) for each patient. Baseline characteristics, co-morbidities, survival status and outcomes were obtained by linking the SwedeHF with two other Swedish registries. We used Kaplan-Meier curves to present time to all-cause mortality, cumulative incidence function for time to CV mortality and Cox proportional hazards model to evaluate the relative difference between AS-HFrEF and AS-HFpEF and AS-HF and controls. The crude all-cause mortality was 49.0%, CV mortality 27.9% in AS-HF patients, respectively 44.7% and 26.6% in matched controls. The adjusted risk for all-cause mortality and CV mortality was similar in HF, regardless of LVEF vs. controls. No significant difference in factors predicting higher all-cause mortality was observed in AS-HFrEF vs. AS-HFpEF, except for diabetes (only in AS-HFrEF), with statistically significant interaction predicting death between the two groups.
Conclusions:
In this nationwide SwedeHF study, we characterized incident HF population after AVI. We found no significant differences in all-cause and CV mortality compared with general HF population. They had virtually the same predictors for mortality, regardless of LVEF.
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